More on Gait and Vision:  Along the lines of Binocular Parallax….

Yesterdays post talked about vision and parallax. Today’s explores some adaptations we have to poor visual quality. (Note 3 pictures today, toggle amongst them.)

In the attached study, we see people with poorer vision quality had 3 particular gait parameters (although probably had many more parameters) which changed with vision quality:

1. shorter step length

2. less trunk flexion

3. earlier heel contact with the ground (which goes along with shorter step length.)

If we think about what we know about the nervous system, this all makes sense. There are 3 systems that keep us upright in the gravitational plane: vision, the vestibular system and the proprioceptive system. If we remove one of the systems, the other 2 become enhanced (or better said, they had better become enhanced).

In this study they took away (or impaired) vision. This left the vestibular and proprioceptive systems to take over. The vestibular system affects position of the HEAD ONLY and measures linear and angular acceleration.  It makes sense to say that a more upright posture would do wonders for the stability of the system. The semicircular canals found in the inner ear measure angular motion, or rotation. Placing the body upright shifts the position of the semicircular canals in a different posture (particularly the LATERAL semicircular canal, which sits at 30 degrees to the horizontal; ) and places the utricle and saccule (which measure tilt and linear acceleration) in a better position to appreciate these. Translation, correct upright posture and neutral head positioning are critical for their contribution to detecting and maintaining balance and spacial stability.

The study also suggests that earlier heel contact in gait creates an “exploration” of the ground. This is quite important because the foot has so much cortical representation (see bottom picture) and is important for proprioception owing to its 31 articulations LOADED with joint mechanoreceptors, not to mention 4 LAYERS of muscles, LOADED with spindles and Golgi Tendon Organs.  The foot is a highly dense sensory receptor, the problem is we have had it hibernating in shoes for far too long. Imagine the advantage to balance, gait and posture we might have if we hadn’t dampened the mechano-sensory receptors for the better part of our lives. 

So, bringing this all full circle with the study; If you have poor vision, you had better make up for it with good upright posture and a sensory system that is unimpaired.  Most of us could have better posture and could use some retraining of foot function and sensory reception. Blind people generally have good postural and environmental awareness. They are not slouched over leading their gait head first while wearing oven mits on their hands and rigid steel-toed work boots. They take advantage of these systems and optimize them.

Sometimes the simple answers are not as simple as we like, but it is nice to know there is a reason.

The Gait Guys….Providing both simple answers to complex problems and complex answers to apparently simple ones.

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Study: Low vision affects dynamic stability of gait

Gait Posture. 2010 Oct;32(4):547-51. Low vision affects dynamic stability of gait. Hallemans A, Ortibus E, Meire F, Aerts P. Source

Research group of Functional Morphology, Department of Biology, University of Antwerp, Belgium. ann.hallemans@ua.ac.be

Abstract

The objective of this study was to demonstrate specific differences in gait patterns between those with and without a visual impairment… .  Adults with a visual impairment walked with a shorter stride length (1.14 ± 0.21m), less trunk flexion (4.55 ± 5.14°) and an earlier plantar foot contact at heel strike (1.83 ± 3.49°) than sighted individuals (1.39 ± 0.08 m; 11.07 ± 4.01°; 5.10 ± 3.53°). When sighted individuals were blindfolded (no vision condition) they showed similar gait adaptations as well as a slower walking speed (0.84 ± 0.28 ms(-1)), a lower cadence (96.88 ± 13.71 steps min(-1)) and limited movements of the hip (38.24 ± 6.27°) and the ankle in the saggital plane (-5.60 ± 5.07°) compared to a full vision condition (1.27 ± 0.13 ms(-1); 110.55 ± 7.09 steps min(-1); 45.32 ± 4.57°; -16.51 ± .59°). Results showed that even in an uncluttered environment vision is important for locomotion control. The differences between those with and without a visual impairment, and between the full vision and no vision conditions, may reflect a more cautious walking strategy and adaptive changes employed to use the foot to probe the ground for haptic exploration.

homunculus photo courtesy of : http://joecicinelli.com/homunculus-training/

Left foot pain in a 30 year runner.→

Hi,

I could use some help. I’ve been running/cycling for 30 years. Three years ago, I had surgery on my left knee that realigned my patella (lateral release.) Until recently, I lived in custom orthotics and motion control shoes. I’ve been reading chi-running and natural running and bought a pair of shoes for which I’m transitioning a little a day. My left foot is the problem: it severly overpronates and I have a neuroma. I’ve been walking barefoot and in five-fingers for a while and my feet a definitely getting much better. The natural running style feels much better on my ankles,knees and hips, which used to hurt a lot. Also, cycling hurts only when I get off my bike, my knee is killing me for a while.

My left forefront seems to move too much even with this new style of walking/running. I’m wondering if I have forefront varus that could be helped with a wedge. My real problem is that I currently live in Las Cruces, NM, where there is no running store and no experts on this stuff. Most podiatrists do the same, generic thing for all patients. Is there a little wedge I could try without having it inserted into a custom orthotic? Is there a place to go to analyze my gait/running that would be worth my time and expense to visit? Any advice would be gratefully received.

Thanks for your time,

AT

Thanks for the note AT.

We are glad that the natural style running is helping. remember to go slowly and follow the rules of Skill, Endurance, Strength as you progress into less supportive shoes.

The forefoot motion you are sensing may indeed be a forefoot varus; we would need to see and examine your foot to know for sure. If it is a rigid deformity, it may never totally be gone, though you may be able to increase the range of motion of your foot sufficiently to compensate elsewhere.

Getting a thorough evaluation is paramount. We are not aware of any gait labs in Las Cruces, but Jaqueline Perry’s Pathokinesiology lab is in Rancho Los Amigos (click here for more info). Dr Waerlop is located about 70 miles west of Denver and Dr Allen is in the Chicago suburbs. Only after an evaluation, could exercise suggestions or an orthotic or other device recommendation could be made.

Thanks for your inquiry

Ivo and Shawn

Just going over our FaceBook stats today: 

Did you know a significant part of our readership is international? Current readership= UK, Canada, Australia, Sweden, Brazil, Singapore, Germany, Mexico, Netherlands, India, Ireland, Israel, Pakistan, France, Denmark, United Arab Emirates, Argentina, Spain, USA !!!!!!!!  The Gait Guys, moving towards global gait domination ! www.thegaitguys.tumblr.com  Just wait for the website to launch ! 2 more weeks we hope !

Have a great weekend brethren !

Shawn and Ivo

Gait / Running Talk: Functional Hallux Limitus.

(*2 pictures attached today, toggle between the two and then read on. PS: the subheader for the photo suggests they recommend a Cheilectomy in many cases.. This was typing that came with the photo. This is not our recommendation in many cases.  Please ignore those two lines of type for now. TGG)

It is often though from an evaluation perspective that hallux limitus is a loss of the big toe extending on the forefoot (metatarsal head), such as seen in the picture above.  It is after all the easiest way to assess the joint, however it is not a true functional assessment, rather a passive ROM assessment.  Keen observers will realize that under more functional circumstances, after planting the foot on the ground, the big toe will be affixed to the ground and the limitation will come as the person attempts to move the body over that joint. With a hallux limitus the 1st metatarsal will not be able to roll downwards on the phalanx (big toe) concavity and gain purchase on the ground. This can come from joint arthrosis or some of the functional problems we have discuss in our last 2 blog posts.  This downward roll and glide, plus the body mass moving over the axis, is “functional extension” at that joint (as opposed to passive assessment function of the joint as seen in the first picture above). This joint can be referred to as the Windlass joint. Here we have the concave rounded metatarsal head (see 2nd picture) rolling up but sliding down withing the concavity of the hallux/ big  toe (roll and glide are normally in opposite directions if the axis of joint centration can be held, in functional hallux limitus this centration axis is lost, hence the limitation) . This roll and glide in descending the metatarsal head to the ground is what we refer to as “medial tripod anchoring”. Disruption of this roll and glide at these joint surfaces through this extension movement to get the metatarsal head to the ground can be found with both Functional or Ablative (true) Hallux Limitus (aka “turf toe”).  Failure of this biomechanical mechanism leads to insufficient medial tripod, aberrant toe off mechanics, probably pain, and risk for bunion and hallux valgus formation (because when the medial tripod is not anchored the functional mechanics of the adductor hallucis muscle changes and ends up pulling the hallux laterally). 

Just taking you through a more functional perspective on hallux limitus. It is not as simple as “the joint is stuck”. And forcing the range won’t make it unstuck ! It will just create more dorsal bony abutment at the top of the joint, and pain.  If you have any chance of fixing this monumentally misunderstood problem, you must understand this blog posting, and the last two blog posts.  To fix this problem, if it is still functional and not ablative (fixed and permanent),  you will have to use your brain and not your fingers ! 

On another day we will talk about the cluffy wedge that you see under the big toe (hallux) in the picture above. We will give you our perspective on the device, how we make our own version of a wedge and some of our concerns for its use.

Alot of our patients joke around when they come in to see us with a problem.  We like humor in our offices.  Their joke frequently is, “must be something wrong with that big toe again !”….. even if it is shoulder or neck pain.  And interestingly, alot of the time they are somewhat right.  If you screw up toe off, the rest of the movement is compensation. 

The Big toe, …… it is often on the menu.

Shawn and Ivo

Welcome to Friday Follies.

Here we see people putting their foot in their mouth….

Have a great day

Ivo and Shawn

The extensor hallucis brevis revisited…or……axes of rotation

In a previous post, we described the attachments and importance of this little, but important muscle. Today we will explore that further.(4 images above, toggle through them)

We recall that the EHB is not only a dorsiflexor of the proximal hallux, but also a descender of the head of the 1st metatarsal . Why is this so important?

The central axis of a joint (sometimes called the instantaneous axis of motion) is the center of movement of that articulation. It is the location where the motion will occur around, much like the center of a wheel, where the axle attaches. In an articulation, it usually involves one bone moving around another. Lets look at an example with a door hinge.

A hinge is similar to a joint, in that it has parts with is joining together (the door and the jamb), with a “joint” in between, The axis of rotation of the hinge is at the pivot rod. When the door, hinge and jamb are all aligned, it functions smoothly. Now imagine that the hinge was attached to the jamb 1/4” off center. What would happen? The hinge would bind and the door would not operate smoothly.

Now let’s think about the 1st metatarsal phalangeal joint. It exists between the head of the 1st metatarsal and the proximal part of the proximal part of the proximal phalanyx. Normally, because the head of the 1st metatarsal is larger than the heads of the lesser ones, the center of the joint is higher (actually,almost 2X as high; 8mm as opposed to 15mm). We also remember that the 1st metatarsal is usually shorter then the 2nd, meaning during a gait cycle, it bears the brunt of the weight and hits the ground earlier than the head of the 2nd.

The head of the 1st metatarsal should slide (or should we say glide?) posteriorly on the sesamoids during dorsiflexion of the hallux at pre swing (toe off). It is able to do this because of the descent of the head of the 1st metatarsal, which causes a dorsal posterior shift of the axis of rotation of the joint. We remember that the head of the 1st descends through the conjoined efforts of supination and the coordinated efforts of the peroneus longus, extensor hallucis brevis, extensor hallucis longus, dorsal and plantar interossei and flexor hallucis brevis (which nicely moves the sesamoids and keeps the process gong smoothly).

Suffice it to say, if things go awry, the axis does not shift, the sesamoids do not move, and the phalanyx crashes into the 1st metatarsal, causing pain and if it continues, a nice spur you can write home about.

Ivo and Shawn….Still Bald…Still good looking…still promoting foot literacy everywhere

Gait / Running: Problems with Big toe pain or power ? The Big toe in motion: another look at a past video we did on EHB and impact on the big toe ! Enjoy this blast from our recent past……. 2.5 years ago……  this video is worth your 5 minutes if you want to get smarter at this stuff !

enjoy…….. Shawn and Ivo

Gait Topic: The Mighty EHB (The Short extensor of the big toe, do not dismiss it !)

Look at this beautiful muscle in a foot that has not yet been exposed to hard planar surfaces and shoes that limit or alter motion! (2 pics above, toggle back and forth)

The Extensor Hallicus Brevis, or EHB as we fondly call it (beautifully pictured above causing the  extension (dorsiflexion) of the child’s proximal big toe) is an important muscle for descending the distal aspect of the 1st ray complex (1st metatarsal and medial cunieform) as well as extending the 1st metatarsophalangeal joint. It is in part responsible for affixing the medial tripod of the foot to the ground.  Its motion is generally triplanar, with the position being 45 degrees from the saggital (midline) plane and 45 degrees from the frontal (coronal) plane, angled medially, which places it almost parallel with the transverse plane. With pronation, it is believed to favor adduction (reference). Did you ever watch our video from 2 years ago ? If not, here it is, you will see good EHB demo and function in this video. click here

It arises from the anterior calcaneus and inserts on the dorsal aspect of the proximal phalynx. It is that quarter dollar sized fleshy protruding, mass on the lateral aspect of the dorsal foot.  The EHB is the upper part of that mass. It is innervated by the lateral portion of one of the terminal branches of the deep peronel nerve (S1, S2), which happens to be the same as the extensor digitorum brevis (EDB), which is why some sources believe it is actually the medial part of that muscle. It appears to fire from loading response to nearly toe off, just like the EDB; another reason it may phylogenetically represent an extension of the same muscle.

*The EDB and EHB are quite frequently damaged during inversion sprains but few seem to ever look to assess it, largely out of ignorance. We had a young runner this past year who had clearly torn just the EHB and could not engage it at all. He was being treated for lateral ankle ligament injury when clearly the problem was the EHB, the lateral ligamentous system had healed fine and this residual was his chief problem.  Thankfully we got the case on film so we will present this one soon for you !  In chronic cases we have been known to take xrays on a non-standard tangential view (local radiographic clinics hate us, but learn alot from our creativity) to demonstrate small bony avulsion fragments proving its damage in unresolving chronic ankle sprains not to mention small myositis ossificans deposits within the muscle mass proper.

Because the tendon travels behind the axis of rotation of the 1st metatarsal phalangeal joint, in addition to providing extension of the proximal phalynx of the hallux (as seen in the child above), it can also provide a downward moment on the distal 1st metatarsal (when properly coupled to and temporally sequenced with the flexor hallicus brevis and longus), assisting in formation of the foot tripod we have all come to love (the head of the 1st met, the head of the 5th met and the calcaneus).

Wow, all that from a little muscle on the dorsum of the foot.

The Gait Guys. Definitive Foot Geeks. We are the kind of people your podiatrist warned you about…

This week for neuromechanics, something a little different. A fun video by Mark Gungor about the differences between male and female brains. Sit back, relax and prepare to laugh!

Of interesting historical note; he describes the differences between the male and female brains perfectly as the contrast to early neuronal theory out forth by Ramon Satiago Cajal: Prior to the 1800’s it was thought the nervous system was continuous (much like the female brain wiring) however he (Ramon) proved it was contiguous (ie. there were synapses).

The Gait Guys….Thinking outside the box, even though we have a special “gait box” in our brains.

Ivo and Shawn

We’ve got an angle….. The Progression Angle

1st of a non sequential series

The progression angle is the angle to foot makes with the ground at initial contact of gait to loading response, and it is often carried through the gait cycle to toe off (see left image above). It is something we often look at to see how a patient may be compensating. It often represents how forces are traveling through the foot (see right image above).

The normal line of force through the foot during a gait cycle should begin at the lateral aspect of the heel, travel up the lateral column of the foot, across the metatarsal heads from the 5th to the 1st, and then through the hallux (see L part of right picture above.

We remember that the foot strikes the ground in a supinated posture, then pronates from initial contact through the middle of midstance (to provide shock absorption and initiate medial spin of the lower extremity: see picture bottom left); the foot should then supinate, to make the foot into a rigid lever, with this being initiated by the opposite limb going into swing and externally rotating the stance phase lower extremity (se picture bottom right)

The progression angle is determined by many factors, both anatomical and functional, and is often a blend of the 2.

Anatomical factors include:

• subtalar joint positioning
• tibial torsion
• femoral torsion
• acetabular dysplasia

and functional causes can include:

• compensation for a hallux limitus or rigidus
• weak glutes (of course we wouldn’t leave our favorite muscle out)
• loss of ankle rocker
• over or under pronation
• and the list goes on….

Next time we begin breaking this down into bite sized chunks to aid digestion.

Ivo and Shawn. Bald. Good Looking. Middle Aged. Definitive Foot and Gait Geeks : )

The Gluteus Maximus: Part 2. More talk on gluteal function & its place in the gait and running cycle.

The gluteus maximus controls:

Flexion / Extension: The Sagittal Plane
- the rate and extent of limb flexion at term swing: this is eccentrically controlled
- hip extension: this is concentrically controlled
- hip flexion rate during loading response (eccentric at foot loading): this will help to control the vertical loading response as the body mass loads the limb there must be enough eccentric strength of the glute maximus to control-stop this loading so that hip extension can occur. This will indirectly assist in control some of knee flexion.

Rotation:
- external rotation of the limb: this is concentrically controlled
- assists in controlling the rate of internal rotation: this is eccentrically controlled

Pelvic Posturing:

- controls rate of Anterior Pelvic Tilt (APT): this is eccentrically controlled (this is relative hip extension as discussed in Part 1 last week)

- assists in Posterior Pelvic Tilt (PPT): this is concentrically driven

- controls sacroiliac joint mobility through FORCE CLOSURE (force closure is a compression of the joint surfaces by the contraction of muscles that cross the joint)

Divisions:

- the sacral division of the gluteus maximus is mostly a pure sagittal plane driver at the hip joint
- the coccygeal division is more of an adductor and internal rotator at the hip joint
- the iliac division is more of an abductor and external rotator at the hip joint

The gluteus maximus also has some fascial attachments into the posterior aspect of the TFL-ITBand. Remember, this TFL-ITB complex is an internal rotator of the limb in the gait cycle. You will recall that internal rotation is a precursor to hip extension. The hip must first, and adequately, internally rotate in the gait cycle before hip extension can occur. This means that for correct and complete gluteus maximus contraction to occur in the second half of the stance phase we must have adequate internal hip rotation. Without it, all of the things we talked about last week in our glut maximus blog post cannot occur properly. Now, back to our attachment disucssion of the gluteus maximus to the ITB-TFL mechanism. This attachment allows the gluteus maximus to produce posterior tension on the ITB-TFL mechanism so that it can be anchored to provide it’s internal rotation function on the limb. So, here we have a powerful hip extensor and external rotator providing assisted effects on an internal rotator of the limb. Isn’t the body a beautiful and amazing thing ! (Well it is. But if you will recall from the detailed layout above that the gluteus maximus in the eccentric phase of contraction functions to control the rate of internal hip rotation you will not be surprised or enlightened. Rather you will enjoy the brilliance of how an anchoring muscle is eccentrically giving up length while an agonist muscle is concentrically taking up length). The gluteus maximus-TFL relationship….. it is beautiful teamwork in helping, not exclusively of course, control limb rotation during loading responses.

Next time you see a client’s knee drift too far inwards during a lunge, or walking or running we hope this whole discussion will spring a light bulb moment for you. You must look at the complex function above in controlling the limb during pronation and supination. Merely inserting an orthotic is not going to fix a proximal deficiency, it could modulate it however. But wouldn’t you want to fix it ? Who wants an orthotic if you don’t need one ? Some people do, don’t get us wrong, but many do not. And then some just need them temporarily to gain the awareness and skill of posturing and function and once that is achieved the device and be weaned.

Just some more functional anatomy talk on a Monday morning…….from us, The Gait Guys

Shawn & Ivo

Gait and Foot pain in a 30 year runner. A possible Forefoot varus.

Hi Gait Guys:

I could use some help. I’ve been running/cycling for 30 years. Three years ago, I had surgery on my left knee that realigned my patella (lateral release.) Until recently, I lived in custom orthotics and motion control shoes. I’ve been reading chi-running and natural running and bought a pair of shoes for which I’m transitioning a little a day. My left foot is the problem: it severly overpronates and I have a neuroma. I’ve been walking barefoot and in five-fingers for a while and my feet a definitely getting much better. The natural running style feels much better on my ankles,knees and hips, which used to hurt a lot. Also, cycling hurts only when I get off my bike, my knee is killing me for a while.

My left forefront seems to move too much even with this new style of walking/running. I’m wondering if I have forefront varus that could be helped with a wedge. My real problem is that I currently live in Las Cruces, NM, where there is no running store and no experts on this stuff. Most podiatrists do the same, generic thing for all patients. Is there a little wedge I could try without having it inserted into a custom orthotic? Is there a place to go to analyze my gait/running that would be worth my time and expense to visit? Any advice would be gratefully received.

Thanks for your time, …. AT

_____________________________________

Thanks for the note AT.

We are glad that the natural style running is helping. remember to go slowly and follow the rules of Skill, Endurance, Strength as you progress into less supportive shoes.

The forefoot motion you are sensing MAY indeed be a forefoot varus; we would need to see and examine your foot to know for sure. The fact that you have had a neuroma and needed a lateral release are suspect for a forefoot varus.  With that 1st metatarsal head (the medial tripod) unstable and allowing more forefoot pronation your control of internal rotation of that limb is going to be difficult and drag patellar tracking off line. If it is a rigid deformity, it may never totally be gone, though you may be able to increase the range of motion of your foot sufficiently to compensate elsewhere. We have attached a photo of a prefabricated forefoot varus post (note its thickness on the outside edge and tapering as it moves inwards to the pre-fab it is attached to. It is a wedge.). In our in-house labs we make them custom to the client to get perfect control. We make them out of thermo-rubber-infused cork so we can grind them down as clients earn better ability to anchor the metatarsal tripod with intrinsic muscle strength through our specific exercise programs. It is also used for Rothbart Foot types which has some similarities to a forefoot varus. Make sure you do not have a Rothbart variant. We did a blog post on Rothbart many years ago. Search for in the search box from our archives.

Getting a thorough evaluation is paramount. We are not aware of any gait labs in Las Cruces, but Jaqueline Perry’s Pathokinesiology lab is in Rancho Los Amigos (click here for more info). Dr Waerlop is located about 70 miles west of Denver and Dr Allen is in the Chicago suburbs. Only after an evaluation, could exercise suggestions or an orthotic or other device recommendation could be made.

Thanks for your inquiry

Ivo and Shawn

Redoing your gait analysis?

Gait Guys:

How often do you need to get a gait analysis done when buying new runners? Started running one year ago and bought my first “real” pair of runners last spring. I have a ‘neutral’ foot or gait. Do I need to get it done now again when buying new ones or should I just go with the neutral runner gain? Does it change much over time with all that mileage?

Name Removed

Our Response:
Your running style will evolve (for better or worse) as you evolve as a runner. If you have had an adequate gait analysis initially, you should probably have a new one done every 6-12 months, depending on your training (style and mileage) and what your ultimate goals may be, especially if you are working at improving your running gait (which we hope you are!).

Ivo and Shawn

READY

Great Gait: You don’t see this that often

Great gait brought to our attention by one our readers; one his questions was how he had such great “kick back” traveling at the speed he was traveling at. 

 

Here is an efficient gait:  note he mid foot strikes (you may need to watch it a few times to see it) close to under body and does not over stride; he has great hip extension, and a forward lean at the ankles; even arm swing (note elbows do not go forward of and wrists do not go behind body). It all adds up!

So what causes such great hip extension? Largely 2 factors: forward momentum and glute (all 3; max, med and min) activation. From the last post and EMG studies, we know the glute max contracts at initial contact (foot stance) through loading response (beginning of mid support) and then again at toe off to give a last “burst”; the gluteus medius and minimus contract during most of stance phase. initially to initiate internal rotation of the femur (a requisite for hip extension);  the former to keep the pelvis level and assist in extension and external rotation during the last half of stance phase to assist in supination and creating a rigid lever to push off of. This is, of course, assisted by the opposite leg in swing phase.

Forward lean and momentum move the axis of rotation of the hip behind the center of gravity, assisting the glute max to extend and prepare the lower limb for the bust at push off. The stance limb, now in external rotation, makes it easier to access the sacral (especially) and iliac fibers of the glute max and the posterior fibers of the gluteus medius.

What a orchestration of biomechanics resulting here, in a symphony of beautiful movement.

The Gait Guys. Bringing you great gait, when available…..

A little something for our triathletes today on Friday Follies.

:-)

S & I (thx Les)

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Are you keeping up with us ? Things are only going to get crazier here at The Gait Guys as we launch some new things.

Gait: When is the last time you used the swear words “closed kinetic chain” ? How well do you understand your Gluteus Maximus ?

These are just some fragmented, early morning, mental ramblings about the genius of the body. We are sure to follow up with more glute talk in time.

When the foot is engaged with the ground one of the major functions of the gluteus maximus is to draw the pelvis into posterior rotation (with some assistance of some other regional muscles of course). The pelvis is extending on the femur through the hip joint axis. If the foot is off the ground one would call this hip extension. But when the foot is on the ground, it is still hip extension, however our mental reference must change. This motion we have described, when the foot has purchase on the ground, is what happens when we return upwards from a squatted position (see ! it is still hip extension). You may find it a brain twister to look at the qluteus maximus also as a rotator of the pelvis away from your foot progression direction. Meaning, we think of the gluteus maximus also as an external rotation generator but when the foot is ground engaged contraction of the G. Max spins our pelvis (and connected torso) away.

Go ahead, stand on your right foot and contract your glute maximus. Which way does your body rotate ?

So, when contracted, if the right foot is on the ground the body pelvis-torso will spin to the left.

So, how do we use our glutes to help us move forward ?

Well, this is a complicated chain of events and this was not the purpose of our ramblings today. This muscle does not work in isolation. Might we just say that there is an opposite swing leg moving forward into flexion which helps to redirect that spin into a sagital progression. Go ahead, stand on that right foot again, contract the glute maximus and note the left rotation, but now add the left forward hip flexion placing the left foot into forward progression. Do you feel that torque and compression through the right hip, core and spine ? Do you have enough core strength to not prostitute the pelvic neutral posturing ? Did you drop into an anterior pelvis tilt (APT) ? Go ahead now, add the anti-phasic motion of contralateral arm swing just to add some more complex rotation to the picture. Are bells and whistles going off about some of your clients problems ? You might want to go back and re-read our work on Arm-Leg swing now. (click here). We plan to build on these concepts in the very near future ….. keep up with us, be ready !

There was alot going on here in what we just did. More on this another day, time to go put this gait stuff to our Friday patients. That is right, we just don’t talk about this stuff, we live it. Remember, unless your patients, clients and athletes wheeled themselves into your facility …… they walked in via the gait cycle. Know your stuff.

Have a great weekend peeps

Shawn & Ivo

“Learn a clean motor skill slowly, add endurance to that slow clean skill, add strength to that skill. Rinse and repeat.
Layering progressive skills and eventual speed to the prior skill achievements … until, like any high end movement endeavor, the task is unconsciously competent. Skipping any step in this logical neurophysiologically based ladder will result in a compensation pattern.”

—

The Gait Guys

Shawn & Ivo

“Form is dictated by Function.”

—

Excerpts from, “Building the Elite Efficient Injury free Athlete”. The topic at this years ITCCCA lecture.

It’s been said “Form follows Function” , to be clear……Form is dictated by Function.

For example, If you do not have good ankle rocker function your Form will:

1- not be optimal
2- require compensation / cheating
3- change, be limited, and prevent desirable Form
(Inefficiency + increased workload = eventual injury or system failure)

Your Form can only be as good as the Functioning of your physical parts.
If you or your athlete has bad Form….. Spending weeks on “running FORM clinics” or training hard to improve a loss of Form may only force new compensations. The solution to better “Form” is often sitting right in front of you in the form of biomechanical dysfunction. When you see bad Form you should ask yourself if that person lacks the functional parts to give you good Form. What you see in someone’s Form are their capabilities with the parts they have that work.

Mind you, some athletes or patients have all normal functioning parts available to them and all they need is Skill coaching or first level skill rehabilitation exercises … the first part of S.E.S. (*Skill, Endurance, Strength). Just always be on the look out for bad function.

Said another way, forcing what you think is good Form will quite often not work on someone with limitations; It will only develop further strength into a compensation pattern that you do not want. Instead, do the necessary initial work to resolve the function limitation so that you can begin to engrain skill Form patterns.

An elite and efficient athlete is one who:
1- has the parts ( sport is matched for body type),
2- presents with no dysfunction … . thus clean FORM,
3- understands that “more is not always better”
4- and has a coach, trainer or medical professional that can teach progressing levels of S.E.S. into that individual.

From this years lecture on “Building the Elite Efficient Injury free Athlete” presented January 14th at the ITCCCA (Illinois Track & Cross Country Coaches Association. This was a standing room only event. We look forward to presenting what we learn in 2012 at next years event. Thanks to all those who endured 2 hours sitting in the stairwells, on the floors and in the seats. Good luck this season everyone !

Shawn, Ivo & Coach Chris Korfist

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